Supervision rating scale: A measure of functional outcome from brain injury

Objective: To introduce a new outcome rating scale, the Supervision Rating Scale (SRS), which measures the level of supervision that a patient receives from caregivers. The SRS rates level of supervision on a 13-point ordinal scale that can optionally be grouped into five ranked categories (Independent, Overnight Supervision, Part-Time Supervision, Full-Time Indirect Supervision, and Full-Time Direct Supervision). Design: Descriptive correlational study of the scale's interrater reliability and criterion-related validity. Setting: Brain injury program of a freestanding rehabilitation hospital. Patients: Referred case series of 114 patients with moderate to severe traumatic brain injury (mean time postinjury = 3.8 years) who resided in the community or a nonhospital facility. Intervention: None. Main Outcome Measures: Functional outcome as measured by the Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), type of living arrangement, and independence in self-care and instrumental activities of daily living (ADL). Results: SRS ratings showed consistent relationships with type of living arrangement and with independence in self-care and instrumental ADL. SRS ratings were also strongly associated with ratings on the DRS and GOS. Interrater reliability of the SRS was evaluated in a subsample of 19 patients and found to be satisfactory (intraclass correlation = .86, weighted kappa = .64). Conclusions: The results suggest that the SRS should have sufficient reliability and validity to serve as a measure of functional outcome from brain injury. Because SRS ratings are based on observed behaviors, the SRS may have a smaller subjective component as compared to the DRS and GOS. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.